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How to Prevent Multiple Births in IVF

It has been the concern of couples; fertility doctors like Dr. Wood, the CDC, SART, and ASRM that IVF fertility treatment, or in-vitro fertilization has been known for increasing the rate of multiple births. Multiples are more likely born prematurely with the consequence of low birth weight, associated medical problems and higher infant mortality rate. However, there are treatment approaches available to you and your fertility doctor that can help reduce the incidence of multiple pregnancies in your IVF cycle.

What is multiple birth risk?

Multiple Birth Risk (MBR), also known as high-order multiple gestation, is the danger or probability of carrying more than one fetus during a single pregnancy. Outside IVF, the chance of a pregnant woman having natural fraternal twins is 1.7% or 1 in 60. The chance for her having identical twins it even less: 0.4% or 1 in 250. Since the introduction of fertility drugs and IVF treatment, the MBR increased significantly in the population. A woman undergoing IVF has a 10 times higher chance of carrying twins or triplets than the natural occurrence. Having twins with IVF is 20-25% or 1 in 4 due to the number of embryos transferred in one IVF cycle. The American Society for Reproductive Medicine (ASRM) is making efforts on lowering the risk of multiple births in IVF. One measure currently in place are strict guidelines for fertility doctors to limit the number of embryos allowed to transfer in an IVF cycle. The current guidelines are as follows (Fertil Steril 2006;86(Suppl 4):S51-52):

ASRM Recommended Limits on number of embryos to transfer

What measures reduces the risk of multiples in IVF?

• Don’t Delay. If you have been unsuccessfully trying to conceive or you know that there is a problem, Dr. Wood advises to seek help by a fertility specialist immediately. The risk of multiple births in IVF is linked to the woman’s maternal age. The younger you are the higher the chance for you to get pregnant with less embryos (see table above) and the lower the risk of having multiples.
• Single embryo transfer. ASRM advises fertility doctors that women undergoing a fresh IVF cycle under the age of 35 with the best diagnosis should be offered a single embryo transfer. Studies showed that success rates of single-embryo transfers are the same as in multiple-embryo transfers. If your doctor recommends transferring more than the ASRM recommenation for your age group, ask for a complete explanation to justify the higher number of embryos. Occasionally, Dr. Wood offers this option also to women over 35 in ideal circumstances and especially when PGD determined a very high embryo quality. Sometimes it is also the patient’s wish to have a single embryo transfer, which Dr. Wood respects.
• Single Blastocyst Transfer. For a single blastocyst transfer, the embryo is matured to the blastocyst stage, and the highest quality blastocyst is chosen to be put back into the uterus. In 2007, researchers at Stanford University School of Medicine found that this technique is especially suited for women over the age of 35 who wish to have only one child. However, older women are less likely to produce high-quality eggs. This technique is not for everyone and should be decided based on individual circumstances and diagnosis. This procedure has been available to RSC patients for years and is a common routine treatment of Dr. Wood.
• Comparative Genomic Hybridization (CGH). CGH is a new form of screening technique similar to PGD and aims to identify the best quality embryo to transfer in an IVF cycle. However, unlike PGD, which is performed on an early stage embryo on Day 3, the CGH biopsy is taken from the outer cell layer during the more mature blastocyst stage on Day 5 without any damage to the embryo. Most importantly, CGH has the advantage to screen for abnormalities of all 23 chromosomes, which has shown to improve IVF success rates and allows reducing the number of embryos per IVF transfer. CGH is currently not available at RSC, but will be offered in the near future to patients of Dr. Wood.

While the ultimate goal of IVF treatment is having a healthy baby, the chance of getting pregnant with IVF and the decision on the number of embryos transferred and techniques used is best evaluated and discussed with your fertility doctor. Dr. Wood uses PGD (preimplantation genetic diagnosis) to determine the embryo quality and to reduce the number of embryos necessary to maximize his patients’ chance of having a baby. If you would like to schedule a consultation with Dr. Samuel Wood, please contact our office.